European agency calls for further study into Pandemrix-narcolepsy linkThe European Medicines Agency (EMA) today added its voice to those calling for more research into the apparent link between the Pandemrix novel H1N1 flu vaccine and narcolepsy in recipients, especially in Finland. The agency's Committee for Medicinal Products for Human Use reviewed data from Finland on narcolepsy in children after they received GlaxoSmithKline's Pandemrix. In a release today the committee said it had "concluded that the new evidence added to the concern arising from case reports in Finland and Sweden, but that the data were still insufficient to establish a causal relationship between Pandemrix and narcolepsy. Further analyses and study results are awaited to clarify the observations in Finland." On Feb 1 Finnish officials said that a Pandemrix-narcolepsy link appeared to be real but that more research was needed. A week later the World Health Organization (WHO) also called for more study into the connection. Further studies are ongoing in both Finland and Sweden, which has also seen an unexpected number of narcolepsy cases.Feb 18 EMA press releaseFeb 1 CIDRAP News story on Finland's findingsFeb 8 WHO statement

Scientists claim potential method for predicting flu virus evolutionAn international team of researchers says it has come up with a potential way to predict the course of influenza virus evolution, by detecting pairs of mutations that tend to follow one another and improve the virus's "fitness," such as its resistance to the immune system or antiviral drugs. The researchers, led by a group at the University of Pennsylvania, studied "epistatic" mutations—ones that have interactive effects, such that the results of one mutation may depend on another one, according to their report in PLoS Genetics. "The first mutation might be useless on its own, but it might be a prerequisite for the second mutation to be useful," senior author Joshua B. Plotkin said in a press release. The team conducted a computational study of 40 years of flu genomes and cataloged pairs of mutations that happened in rapid succession, thus identifying mutations that may be warning signals for other mutations. By this method, using only genomic data, they say they identified sites in the neuraminidase protein that have recently been shown experimentally to confer resistance to oseltamivir (Tamiflu). Previous research on epistasis has focused mainly on mutations that happen more or less simultaneously, whereas Plotkin's research examines changes that are separated by one or more generations, according to the press release. "The knowledge of specific interactions among sites in influenza proteins may help us to predict the course of antigenic evolution and, consequently, to select more appropriate vaccines and drugs," the report says.Feb 17 PLoS GeneticsreportFeb 17 University of Pennsylvania press release

Public health workers report high pandemic workload but little concernDutch public health workers reported a high workload during the 2009 H1N1 influenza pandemic but claimed low stress levels and good compliance with control measures. Of 166 frontline public health workers surveyed, 117 (70.5%) said they were "too busy" during the pandemic, while 13 (7.8%) said their workload became "extreme." Only seven respondents said they were regularly concerned about becoming infected. In terms of applying control measures, the case definition was strictly applied by 66.0% of respondents, and 39.7% consistently consulted the Preparedness and Response Unit, compared with 48.2% who consulted the unit at the pandemic's onset. Of 145 respondents with available data, 128 (88.3%) always used personal protective equipment, and 71.0% to 98.7% discussed isolation measures with patients and their contacts.Feb 17 Eurosurveillancestudy

H5N1 hits poultry farms in India, JapanIndia yesterday reported an H5N1 avian influenza outbreak at a commercial farm in Tripura state, the country's first detection of the disease since June 2010, according to a report from the World Organization for Animal Health (OIE). The virus killed 2,198 of 4,293 poultry at a state duck and poultry farm. Birds within a 3-km radius of the farm are being culled, and poultry sales and transportation have been banned in the area. Investigators haven't determined the source of the outbreak. Tripura state is in northeastern India in an area that borders Bangladesh, which has reported several recent H5N1 outbreaks.Feb 17 OIE report on India outbreakElsewhere, Japan recently reported that the H5N1 virus struck four more poultry farms, including three in Miyazaki prefecture, which has already reported several recent H5N1 outbreaks, according to a report yesterday from the OIE. The three latest outbreaks in Miyazaki occurred between Feb 2 and Feb 5. A total of 424 bird deaths were reported on the farms, and the remaining 158,576 poultry were culled to control the spread of the disease. Meanwhile, the virus struck another farm in Mie prefecture, killing 160 chickens and leading to the culling of 67,000 more, Kyodo News reported on Feb 16.Feb 17 OIE report on Japan outbreaks

FDA says new law defines food importers' safety duty for first timeThe recently enacted US food safety law means that "importers will, for the first time, have a clearly defined responsibility and accountability for the safety of the food they bring into our country," a top Food and Drug Administration (FDA) official said at the Global Food Safety Conference in London yesterday. Michael R. Taylor, FDA deputy commissioner for foods, focused on imported food in his speech at the conference, hosted by the Global Food Safety Initiative. He said the Food Safety Modernization Act requires food importers to provide "adequate assurance" that imported foods have been produced under safeguards equivalent to those required in the US food industry. To help importers accomplish that, the law requires the FDA to set up a system for accrediting third-party auditors of foreign food facilities—"auditors who can verify a firm's or a facility's compliance with US standards with rigor, objectivity, and transparency," Taylor said., adding, "That is a tall order, but we intend to meet it." He said some importers already have safeguards that will meet FDA standards, but others may rely more on third-party auditors. The FDA issued voluntary third-party certification guidance in January 2009, he noted.Michael Taylor's prepared speech

Cholera fatalities still high in rural HaitiUnited Nations (UN) officials said today that Haiti's cholera outbreak seems to be leveling off, but fatality rates in rural areas of the country are still high, the Associated Press (AP) reported. According to Haiti's health ministry, the national mortality rate from the disease is 2%, but in some regions rates are still ranging between 5.9% and 10.7%. The UN said the goal is to get the mortality rate below 1%. Elisabeth Byers, a spokeswoman for the UN's humanitarian office, said rural areas need more intensive response efforts, but more resources are needed. The UN had asked international partners for $175 million to help Haiti battle the outbreak, but so far donors have given only $80 million. According to the most recent figures from Haiti's health ministry, 231,070 cases have been reported, including 4,549 deaths, the AP reported.